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Zaic S, Krajnc N, Macher S, Michl M, Müller N, Mitsch C, Marik W, Novak K, Wöber C, Pemp B, Bsteh G. Therapeutic effect of a single lumbar puncture in idiopathic intracranial hypertension. J Headache Pain 2024; 25:145. [PMID: 39237912 PMCID: PMC11378469 DOI: 10.1186/s10194-024-01851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by increased intracranial pressure. Whilst lumbar puncture (LP) is necessary for the diagnosis of IIH, its therapeutic effect remains unclear. Our aim was to evaluate the therapeutic effect of a single LP in people with IIH (pwIIH). METHODS In this prospective observational study, we analysed short-term neurological and ophthalmological outcomes in pwIIH before, one (D1) and seven days (D7) after the LP. The primary outcome was the change in papilledema degree from baseline. Secondary outcomes included visual outcomes, morphological changes in optical coherence tomography (peripapillary retinal nerve fibre layer [pRNFL] thickness and ganglion cell layer [GCL] volume) and transbulbar sonography (arachnoid optic nerve sheath diameter [AONSD]), and headache outcomes (peak and median headache severity and burden related to headache). RESULTS We included 30 pwIIH (mean age 32.8 years [SD 8.4], 93.3% female, median cerebrospinal fluid [CSF] opening pressure 33.0 cmCSF [IQR 26.9-35.3], median body mass index (BMI) 34.8 kg/m2 [IQR 30.9-40.9]). The median papilledema grading at baseline was 2 (Friedman DI (1999) Pseudotumor cerebri. Neurosurg Clin N Am 10(4):609-621 viii); (Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ (2019) The expanding burden of idiopathic intracranial hypertension. Eye Lond Engl 33(3):478-485); (Ab D, Gt L, Nj V, Sl G, Ml M, Nj N et al. (2007) Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol [Internet]. Apr [cited 2024 Jun 2];143(4). https://pubmed.ncbi.nlm.nih.gov/17386271/ ) and was significantly reduced at D7 (2 [1-2], p = 0.011). Median pRNFL thickness had decreased significantly at D7 (-9 μm [-62.5, -1.3], p = 0.035), with pRNFL thickness at baseline being associated with the pRNFL change (F(1,11) = 18.79, p = 0.001). Mean AONSD had decreased significantly at both D1 (-0.74 mm [0.14], p < 0.001) and D7 (-0.65 mm [0.17], p = 0.01), with AONSD at baseline being associated with the change in AONSD at both time points (D1: β= -0.89, 95% CI -1.37, -0.42, p = 0.002; D7: β= -0.85, 95% CI -1.42, -0.28, p = 0.007). Peak headache severity was slightly lower at D7 (-1/10 [-3, 0], p = 0.026), whereas median headache severity and headache burden remained unchanged. CONCLUSIONS This short-term follow-up study in pwIIH undergoing a single LP suggests a moderate effect on ophthalmological but not headache outcomes. The usefulness of LP as a therapeutic measure in IIH remains controversial and should likely be reserved for patients with limited treatment options, e.g., in pregnancy or intolerability to medication.
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Affiliation(s)
- Sina Zaic
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Nina Müller
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christoph Mitsch
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - Klaus Novak
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
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Branco J, Wang JK, Elze T, Garvin MK, Pasquale LR, Kardon R, Woods B, Szanto D, Kupersmith MJ. Classifying and quantifying changes in papilloedema using machine learning. BMJ Neurol Open 2024; 6:e000503. [PMID: 38952840 PMCID: PMC11216071 DOI: 10.1136/bmjno-2023-000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/20/2024] [Indexed: 07/03/2024] Open
Abstract
Background Machine learning (ML) can differentiate papilloedema from normal optic discs using fundus photos. Currently, papilloedema severity is assessed using the descriptive, ordinal Frisén scale. We hypothesise that ML can quantify papilloedema and detect a treatment effect on papilloedema due to idiopathic intracranial hypertension. Methods We trained a convolutional neural network to assign a Frisén grade to fundus photos taken from the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). We applied modified subject-based fivefold cross-validation to grade 2979 longitudinal images from 158 participants' study eyes (ie, the eye with the worst mean deviation) in the IIHTT. Compared with the human expert-determined grades, we hypothesise that ML-estimated grades can also demonstrate differential changes over time in the IIHTT study eyes between the treatment (acetazolamide (ACZ) plus diet) and placebo (diet only) groups. Findings The average ML-determined grade correlated strongly with the reference standard (r=0.76, p<0.001; mean absolute error=0.54). At the presentation, treatment groups had similar expert-determined and ML-determined Frisén grades. The average ML-determined grade for the ACZ group (1.7, 95% CI 1.5 to 1.8) was significantly lower (p=0.0003) than for the placebo group (2.3, 95% CI 2.0 to 2.5) at the 6-month trial outcome. Interpretation Supervised ML of fundus photos quantified the degree of papilloedema and changes over time reflecting the effects of ACZ. Given the increasing availability of fundus photography, neurologists will be able to use ML to quantify papilloedema on a continuous scale that incorporates the features of the Frisén grade to monitor interventions.
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Affiliation(s)
| | - Jui-Kai Wang
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Tobias Elze
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Mona K Garvin
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Louis R Pasquale
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Randy Kardon
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brian Woods
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Ophthalmology, Cork University Hospital, Cork, Ireland
| | - David Szanto
- Renaissance School of Medicine, Stony Brook, New York, USA
| | - Mark J Kupersmith
- Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Xie JS, Donaldson L, Margolin EA. Swelling of Atrophic Optic Discs in Idiopathic Intracranial Hypertension. J Neuroophthalmol 2024; 44:212-218. [PMID: 37436882 DOI: 10.1097/wno.0000000000001932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Monitoring patients with idiopathic intracranial hypertension (IIH) and optic atrophy may be difficult as papilledema may not be appreciable on ophthalmoscopy. This retrospective chart review evaluated whether papilledema recurrence can be detected in this population using optical coherence tomography (OCT). METHODS Serial clinical assessments, ophthalmoscopy, and peripapillary OCT were reviewed in a cohort of patients with IIH and optic atrophy. Atrophy was defined as moderate if average peripapillary retinal nerve fiber layer (pRNFL) thickness was ≤80 μm and severe if average pRNFL thickness was ≤60 μm on at least 2 consecutive high-quality OCT scans. Based on the upper tolerance limit of test-retest variability, mean pRNFL elevation of ≥6 μm with subsequent decrease to baseline thickness was considered papilledema. RESULTS In a cohort of 165 patients with IIH, 32 eyes of 20 patients and 22 eyes of 12 patients demonstrated moderate and severe optic atrophy, respectively. Over a median follow-up of 198.5 weeks (range, 14.0-428.9), 63.3% (19 of 30) of patients had at least 1 episode of relapse, and 50.0% (15 of 30) had at least 1 episode of papilledema. There was a total of 36 relapse episodes, of which 7 occurred in patients with clinical signs and symptoms but no OCT evidence of relapse, 12 occurred in patients with OCT changes but no clinical signs and symptoms of relapse, and 17 occurred in patients with both clinical and OCT evidence to support relapse. The median percent pRNFL increase in the latter 2 groups was 13.7% (range, 7.5-111.8), and 7 eyes (13.0%) of 5 patients (16.7%) showed thickening greater than 20.0% from baseline. The rate, magnitude, and concordance of pRNFL swelling were similar between moderately vs severely atrophic eyes. CONCLUSIONS Papilledema recurrence can be detected in atrophic optic discs using OCT. All patients with atrophic IIH should be longitudinally monitored with pRNFL measurement. Concurrence of other relapse-suggestive features should prompt further evaluation.
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Affiliation(s)
- Jim Shenchu Xie
- Michael G. DeGroote School of Medicine (JSX), McMaster University, Hamilton, Canada; Division of Ophthalmology (LD), Department of Surgery, McMaster University, Hamilton, Canada; Department of Ophthalmology and Vision Sciences (EAM), University of Toronto, Toronto, Canada; and Division of Neurology (EAM), Department of Medicine, University of Toronto, Toronto, Canada
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Abri Aghdam K, Soltan Sanjari M, Chaibakhsh S, Fathi Z, Kazemi P, Aghajani A. Assessment of the relationship between structural and functional tests in patients with idiopathic intracranial hypertension. Int Ophthalmol 2024; 44:121. [PMID: 38427085 DOI: 10.1007/s10792-024-03054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To assess the relationship between structural and functional tests in mild and moderate idiopathic intracranial hypertension (IIH). METHODS Patients with mild and moderate IIH and a control group were enrolled. Best-corrected visual acuity (BCVA), macular ganglion cell layer (MGCL) thickness, peripapillary retinal nerve fiber layer (pp RNFL) thickness, perimetric mean deviation (MD), and photopic negative responses (PhNR) of the electroretinogram were recorded. The associations between structural (pp RNFL and MGCL thickness) and functional (PhNR amplitude, MD and BCVA) parameters were assessed. RESULTS 154 eyes from 78 subjects (74 eyes from IIH patients and 80 eyes from healthy subjects) were included in this comparative observational study. The MGCL thickness, VA, pp RNFL, and PhNR base-to-trough (BT) amplitude were significantly worse in moderate IIH. The BCVA and MD were associated with MGCL thickness only in moderate IIH. The relationship between MD and MGCL thickness started when MD fell below -5.7 dB. CONCLUSIONS The association between functional and structural parameters varies between mild and moderate IIH. The MD and MGCL thickness outperformed in assessing disease severity in mild and moderate IIH, respectively. The association between MD and MGCL thickness could be considered in IIH severity categorization.
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Affiliation(s)
- Kaveh Abri Aghdam
- Eye Research Center, Eye Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Soltan Sanjari
- Eye Research Center, Eye Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Fathi
- Eye Research Center, Eye Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pegah Kazemi
- Eye Research Center, Eye Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aghajani
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Kaya Tutar N, Kale N. The Relationship between Lumbar Puncture Opening Pressure and Retinal Nerve Fiber Layer Thickness in the Diagnosis of Idiopathic Intracranial Hypertension: Is a Lumbar Puncture Always Necessary? Neurologist 2024; 29:91-95. [PMID: 37839079 DOI: 10.1097/nrl.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Idiopathic intracranial hypertension (IIH), is characterized by elevated intracranial pressure (ICP) without an identified cause. Today, lumbar puncture (LP) is the most common method used for diagnosis by measuring cerebrospinal fluid (CSF) pressure to reflect intracranial pressure. This invasive examination has significant disadvantages, such as complications and negative experiences for patients. Therefore, noninvasive methods for ICP measurement are desired. Optical coherence tomography (OCT) is widely used for the diagnosis and follow-up of IIH patients as it reflects papilledema. The aim of this study is to investigate the relationship between CSF pressure and OCT parameters and the ability of OCT in the diagnostic approach. METHODS In our study, patients who were followed up with a diagnosis of IIH with complete neuro-ophthalmological examinations, including visual acuity (VA), visual field, and OCT imaging within 24 hours before lumbar puncture, were retrospectively evaluated. CSF pressure, visual acuity LogMAR, mean deviation of visual fields, retinal nerve fiber layer (RNFL) thickness measured by OCT, and treatment protocols were obtained from our hospital data system. RESULTS A total of 42 eyes of 21 patients were enrolled in the study. A statistically significant positive and moderate correlation was found between CSF pressure values and average RNFL thickness ( r =0.507; P =0.001). The same relationship was demonstrated in all 4 quadrants: inferior, superior, nasal, and temporal. CONCLUSIONS Increased peripapillary RNFL thickness in optic nerve head OCT may be correlated with increased ICP in IIH patients. A larger number of patients are needed to better understand the correlation between OCT parameters and CSF pressure in patients with IIH.
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Affiliation(s)
- Nurhan Kaya Tutar
- Department of Neurology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Wang JK(R, Linton EF, Johnson BA, Kupersmith MJ, Garvin MK, Kardon RH. Visualization of Optic Nerve Structural Patterns in Papilledema Using Deep Learning Variational Autoencoders. Transl Vis Sci Technol 2024; 13:13. [PMID: 38231498 PMCID: PMC10795546 DOI: 10.1167/tvst.13.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/27/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose To visualize and quantify structural patterns of optic nerve edema encountered in papilledema during treatment. Methods A novel bi-channel deep-learning variational autoencoder (biVAE) model was trained using 1498 optical coherence tomography (OCT) scans of 125 subjects over time from the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) and 791 OCT scans of 96 control subjects from the University of Iowa. An independent test dataset of 70 eyes from 70 papilledema subjects was used to evaluate the ability of the biVAE model to quantify and reconstruct the papilledema spatial patterns from input OCT scans using only two variables. Results The montage color maps of the retinal nerve fiber layer (RNFL) and total retinal thickness (TRT) produced by the biVAE model provided an organized visualization of the variety of morphological patterns of optic disc edema (including differing patterns at similar thickness levels). Treatment effects of acetazolamide versus placebo in the IIHTT were also demonstrated in the latent space. In image reconstruction, the mean signed peripapillary retinal nerve fiber layer thickness (pRNFLT) difference ± SD was -0.12 ± 17.34 µm, the absolute pRNFLT difference was 13.68 ± 10.65 µm, and the RNFL structural similarity index reached 0.91 ± 0.05. Conclusions A wide array of structural patterns of papilledema, integrating the magnitude of disc edema with underlying disc and retinal morphology, can be quantified by just two latent variables. Translational Relevance A biVAE model encodes structural patterns, as well as the correlation between channels, and may be applied to visualize individuals or populations with papilledema throughout treatment.
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Affiliation(s)
- Jui-Kai (Ray) Wang
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, USA
| | - Edward F. Linton
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Brett A. Johnson
- Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Mark J. Kupersmith
- Departments of Neurology, Neurosurgery and Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mona K. Garvin
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, USA
| | - Randy H. Kardon
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Wang H, Cao L, Kwapong WR, Liu G, Wang R, Liu J, Wu B. Optic Nerve Head Changes Measured by Swept Source Optical Coherence Tomography and Angiography in Patients with Intracranial Hypertension. Ophthalmol Ther 2023; 12:3295-3305. [PMID: 37792243 PMCID: PMC10640446 DOI: 10.1007/s40123-023-00822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION This study explored the structural and microvascular changes in the optic nerve head (ONH) of patients with intracranial hypertension (IH) by using swept-source optical coherence tomography (SS-OCT)/OCT angiography (OCTA) and evaluated their association with clinical features. METHODS The optic disc morphology, peripapillary retinal nerve fiber layer (pRNFL), ganglion cell-inner plexiform layer (GCIPL), and microvascular densities of the nerve fiber layer plexus (NFLP), superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP) were measured by the SS-OCT/OCTA tool. Frisen score, visual acuity, and intracranial pressure were assessed and recorded in patients with IH. RESULTS Sixty-one patients with IH and 65 controls were included in this study. Patients with IH showed thicker pRNFL and GCIPL thickness with larger ONH rim area when compared to controls (P < 0.001). Microvascular densities were increased in NFLP while densities were reduced in SVP, ICP, and DCP when compared to controls (P < 0.001). Structural thickness and microvascular densities were significantly correlated with Frisen scores (P < 0.05) and intracranial pressure (P < 0.05) in patients with IH. CONCLUSION Structural and microvasculature variations of the ONH were found in patients with IH compared to controls. Importantly, we showed that structural and microvascular changes in the ONH were correlated with their Frisen score and intracranial pressure in patients with IH.
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Affiliation(s)
- Hang Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - William Robert Kwapong
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Guina Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Ruilin Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
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Yiangou A, Mollan SP, Sinclair AJ. Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms. Nat Rev Neurol 2023; 19:769-785. [PMID: 37957260 DOI: 10.1038/s41582-023-00893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
The understanding of idiopathic intracranial hypertension (IIH) has evolved over the past few years. Previously, IIH was considered a disease exclusively affecting the neuro-ophthalmic axis, characterized by raised intracranial pressure, headache and papilloedema, and resulting in the risk of severe and permanent visual loss and life-changing disabling headaches. Recent advances have begun to redefine IIH as a probable metabolic disease involving a range of systemic manifestations. More than 95% of individuals affected by the disease are women of reproductive age with obesity. The incidence is rapidly rising and parallels the escalating worldwide obesity rates. Contemporary insights identify associations with insulin resistance, type 2 diabetes and a twofold increased risk of cardiovascular disease in excess of that driven by obesity alone. Adipose distribution in people with IIH, like that in other metabolic diseases, is preferentially centripetal and is associated with changes in intracranial pressure. Evidence now demonstrates adipose tissue dysfunction in people with IIH, involving transcriptional and metabolic priming for lipogenesis and weight gain. Hormonal perturbations are also observed, including a unique phenotype of androgen excess that promotes cerebrospinal fluid secretion. Knowledge of these additional disease features is driving research into novel therapeutic targets and altering the approach to multidisciplinary care.
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Affiliation(s)
- Andreas Yiangou
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Susan P Mollan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alexandra J Sinclair
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
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Kwapong WR, Cao L, Pan R, Wang H, Ye C, Tao W, Liu J, Wu B. Retinal microvascular and structural changes in intracranial hypertension patients correlate with intracranial pressure. CNS Neurosci Ther 2023; 29:4093-4101. [PMID: 37287365 PMCID: PMC10651994 DOI: 10.1111/cns.14298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
AIMS We aimed to evaluate the retinal microvascular and structural changes in intracranial hypertension (IH) patients compared with an age- and sex-matched control group. We also investigated the association between clinical parameters and retinal changes in IH patients. METHODS Intracranial hypertension patients were divided into eyes with papilledema (IH-P) and eyes without papilledema (IH-WP). IH patients underwent lumbar puncture to measure intracranial pressure (ICP); visual acuity was performed using the Snellen chart. Optical coherence tomography (OCT) was used to image and measure the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) while OCT angiography was used to image and measure the superficial vascular complex (SVC) and deep vascular complex (DVC). RESULTS Intracranial hypertension patients showed reduced microvascular densities and thinner retinal thicknesses compared with the control group (all p < 0.001). Compared with the control group, IH-P showed reduced microvascular densities and thinner retinal thicknesses (all p < 0.001). IH-P showed reduced SVC density and thinner retinal thicknesses when compared with IH-WP (p = 0.008 for SVC, p = 0.025 for RNFL, and p = 0.018 for GCIPL). ICP correlated with the microvascular densities and GCIPL thickness in IH patients (p = 0.025 for GCIPL, p = 0.004 for SVC, and p = 0.002 for DVC). A significant association of ICP with SVC (p = 0.010) and DVC (p = 0.005) densities were also found in IH-P. CONCLUSIONS Given the observed differences in these noninvasive retinal imaging markers, further research into their clinical utility in IH is needed.
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Affiliation(s)
| | - Le Cao
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Ruosu Pan
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Hang Wang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Chen Ye
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Wendan Tao
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Junfeng Liu
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Bo Wu
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
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Krajnc N, Itariu B, Macher S, Marik W, Harreiter J, Michl M, Novak K, Wöber C, Pemp B, Bsteh G. Treatment with GLP-1 receptor agonists is associated with significant weight loss and favorable headache outcomes in idiopathic intracranial hypertension. J Headache Pain 2023; 24:89. [PMID: 37460968 DOI: 10.1186/s10194-023-01631-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND In idiopathic intracranial hypertension (IIH), sustained weight loss is the main pillar in modifying disease course, whereby glucagon-like peptide-1 receptor agonists (GLP-1-RAs) could present an attractive treatment option. METHODS In this open-label, single-center, case-control pilot study, patients with IIH (pwIIH) and a body mass index (BMI) of ≥ 30 kg/m2 were offered to receive a GLP-1-RA (semaglutide, liraglutide) in addition to the usual care weight management (UCWM). Patients electing for UCWM only served as a control group matched for age-, sex- and BMI (1:2 ratio). The primary endpoint was the percentage weight loss at six months (M6) compared to baseline. Secondary endpoints included the rate of patients with a weight loss of ≥ 10%, monthly headache days (MHD), the rate of patients with a ≥ 30% and ≥ 50% reduction in MHD, visual outcome parameters, and adverse events (AEs). RESULTS We included 39 pwIIH (mean age 33.6 years [SD 8.0], 92.3% female, median BMI 36.3 kg/m2 [IQR 31.4-38.3]), with 13 patients being treated with GLP-1-RAs. At M6, mean weight loss was significantly higher in the GLP-1-RA group (-12.0% [3.3] vs. -2.8% [4.7]; p < 0.001). Accordingly, weight loss of ≥ 10% was more common in this group (69.2% vs. 4.0%; p < 0.001). Median reduction in MHD was significantly higher in the GLP-1-RA group (-4 [-10.5, 0.5] vs. 0 [-3, 1]; p = 0.02), and the 50% responder rate was 76.9% vs. 40.0% (p = 0.04). Visual outcome parameters did not change significantly from baseline to M6. Median reduction in acetazolamide dosage was significantly higher in the GLP-1-RA group (-16.5% [-50, 0] vs. 0% [-25, 50]; p = 0.04). AEs were mild or moderate and attributed to gastrointestinal symptoms in 9/13 patients. None of the AEs led to premature treatment discontinuation. CONCLUSIONS This open-label, single-center pilot study suggests that GLP-1-RAs are an effective and safe treatment option for achieving significant weight loss with a favorable effect on headache, leading to reduced acetazolamide dosage in pwIIH.
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Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
| | - Bianca Itariu
- Department of Internal Medicine III, Division of Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
| | - Wolfgang Marik
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
- Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Internal Medicine III, Division of Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Klaus Novak
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria.
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11
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Bouthour W, Biousse V, Newman NJ. Diagnosis of Optic Disc Oedema: Fundus Features, Ocular Imaging Findings, and Artificial Intelligence. Neuroophthalmology 2023; 47:177-192. [PMID: 37434667 PMCID: PMC10332214 DOI: 10.1080/01658107.2023.2176522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023] Open
Abstract
Optic disc swelling is a manifestation of a broad range of processes affecting the optic nerve head and/or the anterior segment of the optic nerve. Accurately diagnosing optic disc oedema, grading its severity, and recognising its cause, is crucial in order to treat patients in a timely manner and limit vision loss. Some ocular fundus features, in light of a patient's history and visual symptoms, may suggest a specific mechanism or aetiology of the visible disc oedema, but current criteria can at most enable an educated guess as to the most likely cause. In many cases only the clinical evolution and ancillary testing can inform the exact diagnosis. The development of ocular fundus imaging, including colour fundus photography, fluorescein angiography, optical coherence tomography, and multimodal imaging, has provided assistance in quantifying swelling, distinguishing true optic disc oedema from pseudo-optic disc oedema, and differentiating among the numerous causes of acute optic disc oedema. However, the diagnosis of disc oedema is often delayed or not made in busy emergency departments and outpatient neurology clinics. Indeed, most non-eye care providers are not able to accurately perform ocular fundus examination, increasing the risk of diagnostic errors in acute neurological settings. The implementation of non-mydriatic fundus photography and artificial intelligence technology in the diagnostic process addresses these important gaps in clinical practice.
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Affiliation(s)
- Walid Bouthour
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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12
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Abdul-Rahman A, Morgan W, Yu DY. A machine learning approach in the non-invasive prediction of intracranial pressure using Modified Photoplethysmography. PLoS One 2022; 17:e0275417. [PMID: 36174066 PMCID: PMC9521929 DOI: 10.1371/journal.pone.0275417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022] Open
Abstract
The ideal Intracranial pressure (ICP) estimation method should be accurate, reliable, cost-effective, compact, and associated with minimal morbidity/mortality. To this end several described non-invasive methods in ICP estimation have yielded promising results, however the reliability of these techniques have yet to supersede invasive methods of ICP measurement. Over several publications, we described a novel imaging method of Modified Photoplethysmography in the evaluation of the retinal vascular pulse parameters decomposed in the Fourier domain, which enables computationally efficient information filtering of the retinal vascular pulse wave. We applied this method in a population of 21 subjects undergoing lumbar puncture manometry. A regression model was derived by applying an Extreme Gradient Boost (XGB) machine learning algorithm using retinal vascular pulse harmonic regression waveform amplitude (HRWa), first and second harmonic cosine and sine coefficients (an1,2, bn1,2) among other features. Gain and SHapley Additive exPlanation (SHAP) values ranked feature importance in the model. Agreement between the predicted ICP mean, median and peak density with measured ICP was assessed using Bland-Altman bias±standard error. Feature gain of intraocular pressure (IOPi) (arterial = 0.6092, venous = 0.5476), and of the Fourier coefficients, an1 (arterial = 0.1000, venous = 0.1024) ranked highest in the XGB model for both vascular systems. The arterial model SHAP values demonstrated the importance of the laterality of the tested eye (1.2477), which was less prominent in the venous model (0.8710). External validation was achieved using seven hold-out test cases, where the median venous predicted ICP showed better agreement with measured ICP. Although the Bland-Altman bias from the venous model (0.034±1.8013 cm water (p<0.99)) was lower compared to that of the arterial model (0.139±1.6545 cm water (p<0.94)), the arterial model provided a potential avenue for internal validation of the prediction. This approach can potentially be integrated into a neurological clinical decision algorithm to evaluate the indication for lumbar puncture.
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Affiliation(s)
- Anmar Abdul-Rahman
- Department of Ophthalmology, Counties Manukau District Health Board, Auckland, New Zealand
- * E-mail:
| | - William Morgan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Dao-Yi Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, University of Western Australia, Perth, Australia
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13
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Taha Najim R, Mybeck L, Andersson S, Andersson Grönlund M. Thinner peripapillary retinal nerve fibre layer and macular retinal thickness in adolescents with surgically treated hydrocephalus in infancy. Acta Ophthalmol 2022; 100:673-681. [PMID: 35507694 DOI: 10.1111/aos.15162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/21/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To map the morphology of the retina and optic disc in adolescents with surgically treated hydrocephalus (HC) in infancy and to compare the results with healthy controls. METHODS The study comprised 26 adolescents (16 male, mean age 15 years) with HC and 31 sex- and aged-matched controls. The following optical coherence tomography (OCT) parameters were obtained: macular retinal thickness (MRT) and volume (MRV), thickness of the macular and peripapillary retinal nerve fibre layer (ppRNFL), and area of the optic disc, cup and rim. RESULTS The MRT was thinner amongst those with HC compared with controls (right eye (RE) 262.2 ± 15.3 and 275.8 ± 15.1 μm; p = 0.0051), and the MRV was smaller (RE 7.37 ± 0.36 and 7.83 ± 0.35 mm3 ; p = 0.0002). The HC group showed a thinner ppRNFL (RE 88.3 ± 14.9 and 103.5 ± 8.1 μm; p = 0.0002) but a thicker central macular RNFL (RE 11.6 ± 10.4 and 2.07 ± 3.00 μm; p = <0.0001) and foveal minimum (RE 211.1 ± 32.0 and 186.3 ± 15.9 μm; p = 0.0013). Optic disc variables showed no difference between groups. Correlations were found in the HC group between best corrected visual acuity (expressed in logMAR) and ppRNFL (RE r = -0.56, p = 0.018), and disc area (RE r = -0.52, p = 0.033). CONCLUSION Thinner ppRNFL and MRT and smaller MRV were found in adolescents with surgically treated HC in infancy compared with controls. In contrast, the central macular RNFL and foveal minimum were thicker. Further studies are required to evaluate the diagnostic value of OCT to indicate increased intracranial pressure timely and follow-up in individuals with surgically treated HC.
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Affiliation(s)
- Rezhna Taha Najim
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Region Västra Götaland, Sahlgrenska University Hospital Mölndal Sweden
| | - Lovisa Mybeck
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Susann Andersson
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Region Västra Götaland, Sahlgrenska University Hospital Mölndal Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Deparment of Ophthalmology Faculty of Medicine and Health, Örebro University Örebro Sweden
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14
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Akhter A, Schulz L, Inger H, McGregor JM. Current Indications for Management Options in Pseudotumor Cerebri. Neurol Clin 2022; 40:391-404. [DOI: 10.1016/j.ncl.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Quantified Retinal Morphology and Its Association With Papilledema and Visual Acuity in Syndromic and Complex Craniosynostosis: An Optical Coherence Tomography Study. Am J Ophthalmol 2022; 235:38-45. [PMID: 34487703 DOI: 10.1016/j.ajo.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE This study is the first to evaluate the prevalence of retinal thinning and the correlation with papilledema and visual acuity (VA) in a large population with craniosynostosis. DESIGN Prospective clinical cohort study. METHODS All and complex patients syndromic and complex with craniosynostosis who visited the only national referral center between 2018 and 2020 were included. Retinal layers were segmented using optical coherence tomography. Patients were seen by an ophthalmologist for VA assessment and fundoscopy. Multivariate regression models were developed to evaluate correlations between retinal thickness, papilledema and VA. RESULTS We included 127 patients. Retinal thinning was most prevalent in the peripapillary retinal nerve fiber layer (≤38%). A longer duration of papilledema in early childhood correlated with an increased peripapillary retinal nerve fiber layer and total retinal thickness optic nerve head later in life (+0.3 ± 0.2, P = .04 and +1.0 ± 1.0, P = .003); however, its thickness was not correlated with the VA (P = .20 and P = .53). Macular retinal thinning was associated with a worse VA (P = .01); however, it was not correlated with the duration of papilledema (P = .95). CONCLUSIONS Following a preventative treatment strategy for syndromic and complex craniosynostosis, the prevalence of retinal ONH thinning is low. Although the prevalence of peripapillary retinal nerve fiber layer thinning is considerable, its thickness is not correlated with VA. In contrast, macular thinning is correlated with worse VA scores and should, therefore, be evaluated during follow-up. Future studies should evaluate the (1) causative mechanism for macular thinning, (2) correlation between the time to surgery and macular thinning, and (3) results of reactive treatment strategies and compare those results to the current study.
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16
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Jacobsen HH, Jørstad ØK, Moe MC, Petrovski G, Pripp AH, Sandell T, Eide PK. Noninvasive Estimation of Pulsatile and Static Intracranial Pressure by Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:31. [PMID: 35050344 PMCID: PMC8787623 DOI: 10.1167/tvst.11.1.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the ability of optical coherence tomography (OCT) to noninvasively estimate pulsatile and static intracranial pressure (ICP). Methods An OCT examination was performed in patients who underwent continuous overnight monitoring of the pulsatile and static ICP for diagnostic purpose. We included two patient groups, patients with idiopathic intracranial hypertension (IIH; n = 20) and patients with no verified cerebrospinal fluid disturbances (reference; n = 12). Several OCT parameters were acquired using spectral-domain OCT (RS-3000 Advance; NIDEK, Singapore). The ICP measurements were obtained using a parenchymal sensor (Codman ICP MicroSensor; Johnson & Johnson, Raynham, MA, USA). The pulsatile ICP was determined as the mean ICP wave amplitude (MWA), and the static ICP was determined as the mean ICP. Results The peripapillary Bruch's membrane angle (pBA) and the optic nerve head height (ONHH) differed between the IIH and reference groups and correlated with both MWA and mean ICP. Both OCT parameters predicted elevated MWA. Area under the curve and cutoffs were 0.82 (95% confidence interval [CI], 0.66–0.98) and -0.65° (sensitivity/specificity; 0.75/0.92) for pBA and 0.84 (95% CI, 0.70–0.99) and 405 µm (0.88/0.67) for ONHH. Adjusting for age and body mass index resulted in nonsignificant predictive values for mean ICP, whereas the predictive value for MWA remained significant. Conclusions This study provides evidence that the OCT parameters pBA and ONHH noninvasively can predict elevated pulsatile ICP, represented by the MWA. Translational Relevance OCT shows promise as a method for noninvasive estimation of ICP.
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Affiliation(s)
- Henrik Holvin Jacobsen
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten C Moe
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Ophthalmology, University of Split School of Medicine, Split, Croatia
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Tiril Sandell
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Department of Ophthalmology, Vestre Viken Hospital, Drammen, Norway
| | - Per Kristian Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
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17
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van de Beeten SDC, Ramdas WD, Yang S, Loudon SE, den Ottelander BK, Rizopoulos D, van Veelen MLC, Mathijssen IMJ. The use of OCT to detect signs of intracranial hypertension in patients with sagittal suture synostosis: Reference values and correlations. Childs Nerv Syst 2022; 38:1937-1947. [PMID: 35972534 PMCID: PMC9522733 DOI: 10.1007/s00381-022-05598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To obtain pediatric normative reference values and determine whether optical coherence tomography (OCT) corresponds better with clinical signs of intracranial hypertension (ICH) compared to the traditional screening method fundoscopy in a large cohort of one type of single suture craniosynostosis. METHODS Control subjects without optic nerve diseases and isolated sagittal synostosis patients aged 3-10 years who underwent fundoscopy and OCT were included in this prospective cohort study. Normative reference values were obtained through bootstrap analysis. Main outcome was the association between peripapillary total retinal thickness (TRT) and total retinal volume (TRV) and appearance on fundoscopy. Signs and symptoms suggestive of ICH, including skull growth arrest, fingerprinting, and headache, were scored. RESULTS Sixty-four healthy controls and 93 isolated sagittal synostosis patients were included. Normative cut-off values for mean TRT are < 256 μm and > 504 μm and for mean TRV < 0.21 mm3 and > 0.39 mm3. TRT was increased in 16 (17%) and TRV in 15 (16%) of 93 patients, compared to only 4 patients with papilledema on fundoscopy (4%). Both parameters were associated with papilledema on fundoscopy (OR = 16.7, p = 0.02, and OR = 18.2, p = 0.01). Skull growth arrest was significantly associated with abnormal OCT parameters (OR = 13.65, p < 0.01). CONCLUSIONS The established cut-off points can be applied to screen for ICH in pediatrics. The present study detected abnormalities with OCT more frequent than with fundoscopy, which were associated with skull growth arrest. Therefore, a combination of OCT, fundoscopy, and skull growth arrest can improve clinical decision-making in craniosynostosis.
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Affiliation(s)
- Stephanie D C van de Beeten
- Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room EE-1591, Postbus 2040, 3000 CA, Wytemaweg 80, 2015 CN, Rotterdam, The Netherlands.
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sumin Yang
- Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room EE-1591, Postbus 2040, 3000 CA, Wytemaweg 80, 2015 CN, Rotterdam, The Netherlands
| | - Sjoukje E Loudon
- Department of Ophthalmology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bianca K den Ottelander
- Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room EE-1591, Postbus 2040, 3000 CA, Wytemaweg 80, 2015 CN, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marie-Lise C van Veelen
- Department of Neurosurgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room SK-1204, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Irene M J Mathijssen
- Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room EE-1591, Postbus 2040, 3000 CA, Wytemaweg 80, 2015 CN, Rotterdam, The Netherlands
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Kaya FS, Arici C. Assessment of peripapillary choroidal thicknesses and optic disc diameters in idiopathic intracranial hypertension. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 58:212-218. [PMID: 34919841 DOI: 10.1016/j.jcjo.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the peripapillary choroidal thickness and optic disc diameter changes in the eyes of patients who had idiopathic intracranial hypertension (IIH) when they had swollen discs and after resolution of the papilledema. DESIGN This is an observational, cross-sectional study. Optical coherence tomography was performed on both eyes of patients with IIH, who had been divided into 2 groups: 18 patients with acute papilledema and 25 patients with resolved papilledema. Twenty healthy participants were also enrolled in this study. METHODS In this observational, cross-sectional study, the thickness of the retinal nerve fibre layer, the peripapillary choroidal thickness (PCT), the ganglion cell complex thickness, and the optic disc diameters were measured using optical coherence tomography. RESULTS In the resolved-papilledema subgroup, PCT in all quadrants was significantly lower than in the control group (p < 0.001 for each). In the acute-papilledema subgroup, PCT in the temporal, inferior, and superior quadrants was significantly less than in the control eyes (p < 0.001, p = 0.003, p = 0.049, respectively). The disc diameters in the vertical and horizontal planes were also significantly larger in the acute-papilledema eyes than in the control eyes and in the resolved papilledema eyes (p < 0.001 for each). CONCLUSION PCT decreases both at the acute and chronic stages of IIH, and optic disc diameter increases in patients with IIH who have swollen discs.
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Affiliation(s)
- Fatma Selin Kaya
- Department of Ophthalmology, Başakşehir Çam ve Sakura City Hospital, Başakşehir, Istanbul, Turkey.
| | - Ceyhun Arici
- Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
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Optic Nerve Angle in Idiopathic Intracranial Hypertension. J Neuroophthalmol 2021; 41:e464-e469. [PMID: 34788243 DOI: 10.1097/wno.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The tortuosity of the optic nerve can be quantified radiologically by measuring the angle of optic nerve deformation (the "optic nerve angle" [ONA]). In patients with idiopathic intracranial hypertension (IIH), lowering the intracranial pressure (ICP) to a normal range by lumbar puncture leads to straightening of the optic nerve and an increase in the measured sagittal ONA on MRI. It is uncertain whether there is any correlation between ONA and cerebrospinal fluid (CSF) opening pressure or visual function. METHODS Retrospective study of patients with and without IIH who had MRI of the brain followed by lumbar puncture with CSF opening pressure within 24 hours of MRI. Before LP and within 24 hours of MRI of the brain, all patients with IIH had neuro-ophthalmologic assessment including visual acuity, Humphrey Visual Field (HVF), and fundus photography. Sagittal ONA was measured on multiplanar T2-SPACE images on a DICOM viewer. Papilledema on the fundus photographs was graded using the Frisén scale. RESULTS Fifty-four patients with IIH and 30 unmatched controls were included. The IIH group was 6.3 years younger (95% CI 2.4-10.3, P = 0.002), had 8.7 kg/m2 higher body mass index (4.9-12.5, P < 0.001), and 26.3% more women (P = 0.011) compared with controls. In both eyes, the ONA was significantly smaller in patients with IIH by 12° compared with controls (7°-17°, P < 0.00001). In the IIH group, no correlation between ONA and the CSF opening pressure was present in either eye (right eye r = 0.19, P = 0.15; left eye r = 0.18, P = 0.19) The ONA did not correlate with logarithm of the minimum angle of resolution visual acuity (right eye r = 0.26, P = 0.063; left eye r = 0.15, P = 0.27), HVF mean deviation (right eye r = 0.0059, P = 0.97; left eye r = -0.069, P = 0.63), or Frisén grade (Spearman's rho right eye 0.058, P = 0.67; left eye 0.14, P = 0.30). CONCLUSIONS The ONA is significantly smaller in patients with IIH compared to controls, but does not correlate with CSF opening pressure, severity of papilledema, or visual function. The ONA may be useful in identifying patients with raised ICP, but not necessarily those with a poor visual prognosis.
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Jivraj I, Cruz CA, Pistilli M, Kohli AA, Liu GT, Shindler KS, Avery RA, Garvin MK, Wang JK, Ross A, Tamhankar MA. Utility of Spectral-Domain Optical Coherence Tomography in Differentiating Papilledema From Pseudopapilledema: A Prospective Longitudinal Study. J Neuroophthalmol 2021; 41:e509-e515. [PMID: 32956225 PMCID: PMC7947021 DOI: 10.1097/wno.0000000000001087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prospective and longitudinal studies assessing the utility of spectral-domain optical coherence tomography (SD-OCT) to differentiate papilledema from pseudopapilledema are lacking. We studied the sensitivity and specificity of baseline and longitudinal changes in SD-OCT parameters with 3D segmentation software to distinguish between papilledema and pseudopapilledema in a cohort of patients referred for evaluation of undiagnosed optic disc elevation. METHODS Fifty-two adult patients with optic disc elevation were enrolled in a prospective longitudinal study. A diagnosis of papilledema was made when there was a change in the appearance of the optic disc elevation on fundus photographs as noted by an independent observer at or before 6 months. The degree of optic disc elevation was graded using the Frisen scale and patients with mild optic disc elevation (Frisen grades 1 and 2) were separately analyzed. SD-OCT parameters including peripapillary retinal nerve fiber layer (pRNFL), total retinal thickness (TRT), paracentral ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, and optic nerve head volume (ONHV) at baseline and within 6 months of follow-up were measured. RESULTS Twenty-seven (52%) patients were diagnosed with papilledema and 25 (48%) with pseudopapilledema. Among patients with mild optic disc elevation (Frisen grades 1 and 2), baseline pRNFL (110.1 µm vs 151.3 µm) and change in pRNFL (ΔpRNFL) (7.3 µm vs 52.3 µm) were greater among those with papilledema. Baseline and absolute changes in TRT and ONHV were also significantly higher among patients with papilledema. The mean GCL-IPL thickness was similar at baseline, but there was a small reduction in GCL-IPL thickness among patients with papilledema. Receiver operator curves (ROCs) were generated; ΔpRNFL (0.93), ΔTRT (0.94), and ΔONHV (0.95) had the highest area under the curve (AUC). CONCLUSIONS The mean baseline and absolute changes in SD-OCT measurements (pRFNL, TRT, and ONHV) were significantly greater among patients with papilledema, and remained significantly greater when patients with mild optic disc elevation were separately analyzed. ROCs demonstrated that ΔpRNFL, ΔTRT, and ΔONHV have the highest AUC and are best able to differentiate between papilledema and pseudopapilledema.
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Affiliation(s)
- Imran Jivraj
- Department Ophthalmology (IJ), University of Alberta, Edmonton, Canada; Perelman School of Medicine at the University of Pennsylvania (CA), Philadelphia, Pennsylvania; Center for Preventative Ophthalmology and Biostatistics at the University of Pennsylvania (MP), Philadelphia, Pennsylvania; Department of Ophthalmology and Visual Science (AAK), Yale School of Medicine, New Haven, Connecticut; Division of Neuro-ophthalmology (GTL, KSS, RAA, AR, MAT), Departments of Ophthalmology and Neurology, Scheie Eye Institute at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for the Prevention and Treatment of Visual Loss (MKG, J-KW), VA Health Care System, Iowa City, Iowa; and Department of Electrical and Computer Engineering (MKG, J-KW), the University of Iowa, Iowa City, Iowa
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21
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Pediatric Intracranial Hypertension: A Spotlight on Imaging, the Idiopathic Intracranial Hypertension Treatment Trial, and COVID-19 Associated Cases. Semin Pediatr Neurol 2021; 40:100922. [PMID: 34749916 DOI: 10.1016/j.spen.2021.100922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
Primary intracranial hypertension (PIH) is characterized by clinical signs of increased intracranial pressure, papilledema, elevated opening pressure, and absence of mass lesion, hydrocephalus, or meningeal enhancement on neuroimaging. Visual changes are a common presenting feature and if untreated there is risk of irreversible vision loss. There have been recent proposed changes to the criteria for PIH along with studies looking at the differences in imaging characteristics between adult and pediatric PIH. The presence of transverse sinus stenosis alone was highly sensitive and specific for pediatric PIH. The Idiopathic Intracranial Hypertension Treatment Trial was an adult, multicenter study that examined the use of acetazolamide and weight loss on the course of PIH. The study confirmed many previously held beliefs including the most common presenting symptom in PIH is headache. Most patients present with bilateral papilledema with 58.2% of patients having symmetric Frisen scale grading and within one grade in 92.8%. Although diplopia is a common reported symptom, very few have evidence of cranial nerve palsy. Male gender, high-grade papilledema, and decreased visual acuity at presentation are risk factors for treatment failure. Acetazolamide use is associated with mild metabolic acidosis. During acetazolamide treatment, monitoring for hypokalemia or aplastic anemia is not recommended. Monitoring transaminases in the titration phase of treatment should be considered due to a case of transaminitis and pancreatitis with elevated lipase. Newer case reports have also seen associations of secondary intracranial hypertension with concurrent COVID-19 infection and MIS-C.
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22
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Xie JS, Donaldson L, Margolin E. Papilledema: A review of etiology, pathophysiology, diagnosis, and management. Surv Ophthalmol 2021; 67:1135-1159. [PMID: 34813854 DOI: 10.1016/j.survophthal.2021.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Papilledema is optic nerve head edema secondary to raised intracranial pressure (ICP). It is distinct from other causes of optic disk edema in that visual function is usually normal in the acute phase. Papilledema is caused by transmission of elevated ICP to the subarachnoid space surrounding the optic nerve that hinders axoplasmic transport within ganglion cell axons. There is ongoing controversy as to whether axoplasmic flow stasis is produced by physical compression of axons or microvascular ischemia. The most common cause of papilledema, especially in patients under the age of 50, is idiopathic intracranial hypertension (IIH); however, conditions that decrease cerebrospinal fluid (CSF) outflow by either causing CSF derangements or mechanically blocking CSF outflow channels, and rarely conditions that increase CSF production, can be the culprit. When papilledema is suspected clinically, blood pressure should be measured, and pseudopapilledema should be ruled out. Magnetic resonance imaging of the brain and orbits with venography sequences is the preferred neuroimaging modality that should be performed next to look for indirect imaging signs of increased ICP and to rule out nonidiopathic causes. Lumbar puncture with measurement of opening pressure and evaluation of CSF composition should then be performed. In patients not in a typical demographic group for IIH, further investigations should be conducted to assess for underlying causes of increased ICP. Magnetic resonance imaging of the neck and spine, magnetic resonance angiography of the brain, computed tomography of the chest, complete blood count, and creatinine testing should be able to identify most secondary causes of intracranial hypertension. Treatment for patients with papilledema should be targeted toward the underlying etiology. Most patients with IIH respond to weight loss and oral acetazolamide. For patients with decreased central acuity and constricted visual fields at presentation, as well as patients who do not respond to treatment with acetazolamide, surgical treatments should be considered, with ventriculoperitoneal shunting being the typical procedure of choice.
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Affiliation(s)
- Jim Shenchu Xie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Laura Donaldson
- Faculty of Medicine, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Edward Margolin
- Faculty of Medicine, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
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23
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Kohen MC, Orge FH. CASE REPORT OF THE ROLE OF OPTICAL COHERENCE TOMOGRAPHY IN RECOMBINANT GROWTH HORMONE THERAPY. Retin Cases Brief Rep 2021; 15:789-794. [PMID: 31568222 PMCID: PMC8542084 DOI: 10.1097/icb.0000000000000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PURPOSE To report the correlation between recombinant growth hormone (rhGH) dosage and retinal nerve fiber layer (RNFL) thickness values measured by optical coherence tomography in a case of pseudotumor cerebri syndrome (PTCS) after rhGH. METHODS An 11-year-old girl was receiving rhGH for panhypopituitarism. The patient developed PTCS, and her rhGH dose was adjusted using optical coherence tomography RNFL thickness measurements. The linear correlation coefficient (r) and coefficient of determination (r2) were calculated to assess the relationship between RNFL thickness and rhGH dose. RESULTS As the rhGH dosage was increased, the RNFL thickness values also increased, especially when acetazolamide was excluded because of its confounding effect. (r = 0.64) In separate subgroup analysis, a higher acetazolamide dosage strongly correlated with reduced RNFL thickness (r = 0.77). CONCLUSION Although PTCS is a rare complication after rhGH therapy, its detrimental effects cannot be ignored. In our case report, we used optical coherence tomography RNFL values in addition to clinical findings to carefully titrate the rhGH dosage to prevent a flare-up of PTCS. Despite the obvious need for larger studies, our case report shows the value of RNFL thickness measured by optical coherence tomography and the valuable additional data it provides to refine rhGH therapy as an adjunct noninvasive method in PTCS.
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Affiliation(s)
- Maryo C Kohen
- Department of Ophthalmology, Cleveland Medical Center University Hospitals, Rainbow Babies and Children's Hospital
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24
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Kaya FS, Sonbahar O, Açar PA, Özbaş M, Yigit FU. Evaulating peripapillary vessel density ın regressed papilledema ın ıdiopathic ıntracranial hypertension patients. Photodiagnosis Photodyn Ther 2021; 36:102551. [PMID: 34571274 DOI: 10.1016/j.pdpdt.2021.102551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the retinal nerve fiber layer (RNFL) thickness, the ganglion cell complex (GCC) and vessel density of the radial peripapillary capillary (RPC) plexus of eyes with regressed papilledema in idiopathic intracranial hypertension (IIH) patients using optical coherence tomography angiography (OCT-A) and comparing the results with healthy controls. MATERIALS AND METHODS Fifty-one eyes of 31 patients diagnosed with IIH and 52 eyes of 52 healthy subjects were enrolled in this study. All patients underwent a complete ophthalmological examination and a 4.5 × 4.5 mm peripapillary OCT-A scanning. The quantitative results of the peripapillary RNFL and GCC thicknesses and vessel density of the RPC were analyzed. RESULTS The vessel density in the inferior, superior nasal, and inferior nasal sectors of the patients with IIH significantly exceeded the vessel density of the healthy controls (P = 0.008, P = 0.008, and P = 0.000, respectively). The RNFL and GCC thickness measurements were comparable in both groups. CONCLUSIONS Patients with IIH show vascular abnormalities in the inferior nasal region, which can be detected with OCT-A. As a noninvasive imaging modality, OCT-A could provide a new perspective for understanding the pathophysiology of IIH and could also be useful in the follow-up of these patients.
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Affiliation(s)
| | | | - Pınar Akarsu Açar
- Bakirkoy Dr Sadi Konuk Training and Research Hospital Ophthalmology Department, Bakirkoy, Istanbul, Turkey
| | - Mehmet Özbaş
- Bakirkoy Dr Sadi Konuk Training and Research Hospital Ophthalmology Department, Bakirkoy, Istanbul, Turkey
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25
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Hagen SM, Wegener M, Toft PB, Fugleholm K, Jensen RH, Hamann S. Unilateral Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension: A 6-Month Follow-Up Study on Visual Outcome and Prognostic Markers. Life (Basel) 2021; 11:778. [PMID: 34440522 PMCID: PMC8400184 DOI: 10.3390/life11080778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Loss of vision is a feared consequence of idiopathic intracranial hypertension (IIH). Optic nerve sheath fenestration (ONSF) may be an effective surgical approach to protect visual function in medically refractory IIH. In this study, we evaluate the impact of unilateral superomedial transconjunctival ONSF on bilateral visual outcome using a comprehensive follow-up program. A retrospective chart review of IIH patients who underwent unilateral ONSF between January 2016 and March 2021 was conducted. Patients fulfilling the revised Friedman criteria for IIH and who had exclusively received ONSF as a surgical treatment were included. Main outcomes were visual acuity (VA); perimetric mean deviation (PMD); papilledema grade; and optic nerve head elevation (maxONHE) 1 week, 2 weeks, and 1, 3, and 6 months after surgery. VA (p < 0.05), PMD (p < 0.05), papilledema grade (p < 0.01), and maxOHNE (p < 0.001) were improved after 6 months on both the operated and non-operated eye. Prolonged surgical delay impedes PMD improvement (r = -0.78, p < 0.01), and an increasing opening pressure initiates a greater ganglion cell loss (r = -0.79, p < 0.01). In this small case series, we demonstrate that unilateral superonasal transconjunctival ONSF is a safe procedure with an effect on both eyes. Optic nerve head elevation and PMD are feasible biomarkers for assessing early treatment efficacy after ONSF.
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Affiliation(s)
- Snorre Malm Hagen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark; (M.W.); (P.B.T.); (S.H.)
| | - Marianne Wegener
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark; (M.W.); (P.B.T.); (S.H.)
| | - Peter Bjerre Toft
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark; (M.W.); (P.B.T.); (S.H.)
| | - Kåre Fugleholm
- Department of Neurosurgery, Rigshospitalet, University of Copenhagen, 2100 Copenhagen Ø, Denmark;
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, 2600 Glostrup, Denmark;
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark; (M.W.); (P.B.T.); (S.H.)
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Kohli AA, Pistilli M, Alfaro C, Ross AG, Jivraj I, Bagchi S, Chan J, May D, Liu GT, Shindler KS, Tamhankar MA. Role of Ocular Ultrasonography to Distinguish Papilledema From Pseudopapilledema. J Neuroophthalmol 2021; 41:206-211. [PMID: 33296160 DOI: 10.1097/wno.0000000000000984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We prospectively evaluated the sensitivity and specificity of ocular ultrasonography (OUS) to distinguish papilledema from pseudopapilledema. METHODS Forty-nine study participants, with optic disc elevation, underwent neuro-ophthalmic evaluation, OUS, fundus photography, and optical coherence tomography (OCT) of the optic nerve head at the initial and follow-up visits (≤6 months apart). Participants were classified as having papilledema if there was a change in optic nerve appearance on fundus photographs, as determined by a masked observer, between initial and follow-up visits ≤6 months apart. OUS was considered positive when the optic nerve sheath width was >3.3 mm and the 30° test was positive. Ocular ultrasonographic findings were correlated in patients who had papilledema vs patients who had pseudopapilledema. In a subanalysis, OUS findings were also correlated with change in peripapillary retinal nerve fiber layer thickness on OCT of the optic nerve head between initial and follow-up visits. RESULTS OUS was 68% (17/25) sensitive for papilledema and 54% (13/24) specific for pseudopapilledema. When using OCT parameters to define papilledema, the sensitivity of OUS to diagnose papilledema decreased to 62%. Positive OUS correlated with elevated opening pressure on lumbar puncture and with signs of increased intracranial pressure on MRI. CONCLUSION OUS alone was less sensitive in diagnosing papilledema than previously thought. Therefore, OUS may not be helpful in distinguishing between papilledema and pseudopapilledema.
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Affiliation(s)
- Anita A Kohli
- Department of Ophthalmology and Visual Science (AAK), Yale University School of Medicine, New Haven, Connecticut; Department of Ophthalmology (MP), Center for Preventative Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Ophthalmology (CA), Icahn School of Medicine at Mount Sinai, New York, New York; Scheie Eye Institute (AGR, GTL, KSS, MAT), Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Ophthalmology (IJ), University of Alberta, Edmonton, Canada ; Department of Medicine (SB), Temple University, Philadelphia, Pennsylvania; Rutgers Robert Wood Johnson Medical School (JC), Piscataway, New Jersey; Boston University Henry M. Goldman School of Dental Medicine (DM), Boston, Massachusetts; and Department of Neurology (GTL), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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27
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Ceylan OM, Yılmaz M, Yilmaz H, Çelikay O, Köylü MT, Turan A. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammation markers in patients with papilledema due to idiopathic intracranial hypertension. Indian J Ophthalmol 2021; 69:1499-1505. [PMID: 34011728 PMCID: PMC8302273 DOI: 10.4103/ijo.ijo_2030_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: The aim of this study was to investigate the role of inflammation in the pathogenesis of idiopathic intracranial hypertension (IIH) using the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as inflammation markers. Methods: The files of 33 IIH patients and 33 controls were screened for this retrospective study. For each patient, the NLR and PLR values were calculated using a single fasting blood sample. For both eyes, papilledema (PE) grades, best-corrected visual acuity (BCVA), retinal nerve fiber layer thickness (RNFLT), and ganglion cell layer thickness (GCLT) measurements were recorded along with the demographic data, including body mass index (BMI), and complete neurological and ophthalmological findings. Comparisons between the two groups and between the IIH patients with and without PE were made. The associations of NLR and PLR with all other parameters were analyzed independently from age, gender, and BMI. Results: NLR and PLR were higher in patients with IIH than controls (P < 0.05). They were also higher in patients with PE (P < 0.05) in the IIH group. NLR and PLR were found to be associated with BCVA (P < 0.001 and P = 0.023, respectively), global RNFLT (P = 0.004 and 0.012, respectively), RNFLT of the temporal quadrant (P < 0.001 and P = 0.042, respectively) and PE grade (P < 0.001 and P = 0.035, respectively). Conclusion: The NLR and PLR values and their associations with BCVA, RNFLT, and PE support the hypothesis that inflammation is a very important component of the pathogenesis of IIH.
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Affiliation(s)
- Osman Melih Ceylan
- Department of Ophthalmology, Gulhane Medical Faculty, Health Sciences University, Ulucanlar Training and Research Hospital, Ankara, Turkey
| | - Mevlüt Yılmaz
- Department of Ophthalmology, Health Sciences University, Ulucanlar Training and Research Hospital, Ankara, Turkey
| | - Hayati Yilmaz
- Department of Ophthalmology, Umraniye Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Osman Çelikay
- Department of Ophthalmology, Dıskapi Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Mehmet Talay Köylü
- Department of Ophthalmology, Gulhane Medical Faculty, Health Sciences University, Ulucanlar Training and Research Hospital, Ankara, Turkey
| | - Aynur Turan
- Department of Radiology, Dıskapi Training and Research Hospital, Health Sciences University, Ankara, Turkey
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28
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Dural venous sinus stenting in the treatment of idiopathic intracranial hypertension: A systematic review and critique of literature. Surv Ophthalmol 2021; 67:271-287. [PMID: 34004224 DOI: 10.1016/j.survophthal.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 12/19/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is increased intracranial pressure without a known cause. Dural venous sinus stenting (DVSS) is a relatively new intervention for treatment of IIH refractory to medical therapy and lifestyle modifications. In this review, we outline various hypotheses of IIH pathogenesis and describe the role of venous sinus stenosis and the technical details of DVSS. We also present a summary and critique of the available evidence describing the outcomes of DVSS in IIH and review the evidence-based guidelines for this procedure. We conclude that, although many studies have shown generally favorable outcomes of DVSS in patients with IIH, most have serious limitations, the most common one being paucity of pre- and postprocedure ophthalmological data. Thus, there is not enough available evidence to conclude whether DVSS is an effective procedure for treatment of IIH. We also present the most commonly used indications for DVSS as described in the literature and stress the importance of neuro-ophthalmological assessment before and after the procedure to monitor response and potential complications.
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29
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Sibony PA, Kupersmith MJ, Kardon RH. Optical Coherence Tomography Neuro-Toolbox for the Diagnosis and Management of Papilledema, Optic Disc Edema, and Pseudopapilledema. J Neuroophthalmol 2021; 41:77-92. [PMID: 32909979 PMCID: PMC7882012 DOI: 10.1097/wno.0000000000001078] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distinguishing optic disc edema from pseudopapilledema is a common, sometimes challenging clinical problem. Advances in spectral-domain optical coherence tomography (SD-OCT) of the optic nerve head (ONH) has proven to be a cost effective, noninvasive, outpatient procedure that may help. At its core are tools that quantify the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL). The SD-OCT also provides a set of tools that may be qualitatively interpreted in the same way that we read an MRI. They include the transverse axial, en face, and circular tomogram. Our goal is to describe a practical office-based set of tools using SD-OCT in the diagnosis and monitoring of papilledema, optic disc edema, and pseudopapilledema. EVIDENCE ACQUISITION Searches on PubMed were performed using combinations of the following key words: OCT, papilledema, pseudopapilledema, optic disc drusen, retinal folds (RF), and choroidal folds (CF). RESULTS The principal elements of SD-OCT analysis of the ONH are the RNFL and GC-IPL thickness; however, these metrics have limitations when swelling is severe. Qualitative interpretation of the transverse axial SD-OCT aids in assessing peripapillary shape that may help distinguish papilledema from pseudopapilledema, evaluate atypical optic neuropathies, diagnose shunt failures, and identify outer RF and CF. There is a consensus that the SD-OCT is the most sensitive way of identifying buried optic disc drusen. En face SD-OCT is especially effective at detecting peripapillary wrinkles and outer retinal creases, both of which are common and distinctive signs of optic disc edema that rule out pseudopapilledema. Mechanically stressing the ONH in the adducted eye position, in patients with papilledema, may expose folds and peripapillary deformations that may not be evident in primary position. We also discuss how to optimize the acquisition and registration of SD-OCT images. CONCLUSIONS The SD-OCT is not a substitute for a complete history and a careful examination. It is, however, a convenient ancillary test that aids in the diagnosis and management of papilledema, optic disc edema, and pseudopapilledema. It is particularly helpful in monitoring changes over the course of time and distinguishing low-grade papilledema from buried drusen. The application of the SD-OCT toolbox depends on optimizing the acquisition of images, understanding its limitations, recognizing common artifacts, and accurately interpreting images in the context of both history and clinical findings.
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Affiliation(s)
- Patrick A Sibony
- Department Ophthalmology (PAS), State University of New York at Stony Brook, Stony Brook, New York; Departments of Neurology, Ophthalmology, Neurosurgery (MJK), Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary, New York, New York; Department of Ophthalmology and Visual Sciences (RHK), the University of Iowa, Iowa City, Iowa; and Center for the Prevention and Treatment of Visual Loss (RHK), Iowa City VA Health Care System, Iowa City, Iowa
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30
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Vijay V, Mollan SP, Mitchell JL, Bilton E, Alimajstorovic Z, Markey KA, Fong A, Walker JK, Lyons HS, Yiangou A, Tsermoulas G, Brock K, Sinclair AJ. Using Optical Coherence Tomography as a Surrogate of Measurements of Intracranial Pressure in Idiopathic Intracranial Hypertension. JAMA Ophthalmol 2021; 138:1264-1271. [PMID: 33090189 DOI: 10.1001/jamaophthalmol.2020.4242] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance There is an unmet need for noninvasive biomarkers of intracranial pressure (ICP), which manifests as papilledema that can be quantified by optical coherence tomography (OCT) imaging. Objective To determine whether OCT of the optic nerve head in papilledema could act as a surrogate measure of ICP. Design, Setting, and Participants This longitudinal cohort study used data collected from 3 randomized clinical trials that were conducted between April 1, 2014, and August 1, 2019. Participants who were female and had active idiopathic intracranial hypertension were enrolled from 5 National Health Service hospitals in the UK. Automated perimetry and OCT imaging were followed immediately by ICP measurement on the same day. Cohort 1 used continuous sitting telemetric ICP monitoring (Raumedic Neurovent P-tel device) on 1 visit. Cohort 2 was evaluated at baseline and after 3, 12, and 24 months and underwent lumbar puncture assessment of ICP. Main Outcomes and Measures Optical coherence tomography measures of the optic nerve head and macula were correlated with ICP levels, Frisén grading, and perimetric mean deviation. The OCT protocol included peripapillary retinal nerve fiber layer, optic nerve head, and macular volume scans (Spectralis [Heidelberg Engineering]). All scans were validated for quality and resegmented manually when required. Results A total of 104 women were recruited. Among cohort 1 (n = 15; mean [SD] age, 28.2 [9.4] years), the range of OCT protocols was evaluated, and optic nerve head central thickness was found to be most closely associated with ICP (right eye: r = 0.60; P = .02; left eye: r = 0.73; P = .002). Subsequently, findings from cohort 2 (n = 89; mean [SD] age, 31.8 [7.5] years) confirmed the correlation between central thickness and ICP longitudinally (12 and 24 months). Finally, bootstrap surrogacy analysis noted a positive association between central thickness and change in ICP at all points (eg, at 12 months, a decrease in central thickness of 50 μm was associated with a decrease in ICP of 5 cm H2O). Conclusions and Relevance In this study, optic nerve head volume measures on OCT (particularly central thickness) reproducibly correlated with ICP and surrogacy analysis demonstrated its ability to inform ICP changes. These data suggest that OCT has the utility to not only monitor papilledema but also noninvasively prognosticate ICP levels in idiopathic intracranial hypertension.
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Affiliation(s)
- Vivek Vijay
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom.,Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - James L Mitchell
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom.,Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Edward Bilton
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Zerin Alimajstorovic
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Keira A Markey
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Anthony Fong
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Department of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jessica K Walker
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Hannah S Lyons
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andreas Yiangou
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom.,Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Georgios Tsermoulas
- Department of Neurosurgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Kristian Brock
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom.,Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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31
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Abstract
Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unknown cause that most often occurs in women of childbearing age. Most patients are overweight or obese with a history of recent weight gain. Following a brief review of the symptoms and signs, we discuss the approach to assessment and monitoring of this condition. We then present a practical approach to treatment. Because patients frequently struggle with weight loss and can also have refractory headaches and coexisting psychosocial issues, we emphasize the importance of a multidisciplinary approach to the management of this common condition.
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Affiliation(s)
- Matthew J Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA 52242, USA; Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - Aki Kawasaki
- University of Lausanne, Hôpital Ophtalmique Jules Gonin, Avenue de France 15, Lausanne 1004, Switzerland.
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32
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Ma Z, Jiang H, Meng C, Cui S, Peng J, Wang J. Idiopathic intracranial hypertension in patients with anemia: A retrospective observational study. PLoS One 2020; 15:e0236828. [PMID: 32735573 PMCID: PMC7394431 DOI: 10.1371/journal.pone.0236828] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) mostly affects obese women in childbearing age, leading to frustrating headache and permanent visual impairment. The exact etiology of this condition is poorly understood, and the population at risk and clinical presentation seems to be homogeneous. However, little attention has been paid to the clinical features of IIH patients with anemia. We herein performed a retrospective observational study by using the data of patients with presumed IIH who were referred to the neurology department of Beijing Tongren Hospital from January 2014 to August 2019 to describe the clinical features and radiological findings in patients with IIH and anemia, and compared these with those without anemia. The patients were divided into two groups based on the presence of anemic diseases. Clinical data including demographic characteristics, clinical features, past medical history, laboratory and neuroradiological findings, diagnoses, treatments and prognosis of these patients were reviewed and compared in both the groups. A total of 153 patients with IIH were enrolled, which included 22 cases with anemia (mean age, 33.23±9.68 years; 19 [86.36%] female) and 131 cases without anemia (mean age 37.11±11.56 years; 97 [74.05%] female). In the anemia group, 19/22 cases had iron deficiency anemia and 3/22 had renal anemia. Compared with patients in the non-anemia group, IIH patients with anemia had a shorter disease course, and tended to present pulsatile tinnitus and transverse sinus stenosis (TSS), faster and better prognosis after treatments for correcting anemia and reducing intracranial pressure. Our findings highlighted the importance of obtaining full blood counts in IIH patients with subacute onset, and provided appropriate and prompt treatments if proven anemic in order to bring better outcomes.
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Affiliation(s)
- Zhonghua Ma
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hanqiu Jiang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Meng
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shilei Cui
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingting Peng
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- * E-mail:
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33
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Elsaid N, Ahmed O, Belal T, Razek A, Azab A. Pathogenesis and Evaluation of the Effects of Idiopathic Intracranial Hypertension on the Optic Nerves. Neuroophthalmology 2020; 44:281-289. [PMID: 33012916 PMCID: PMC7518303 DOI: 10.1080/01658107.2020.1751859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a clinical syndrome of raised intracranial pressure of unknown aetiology. Although papilloedema and visual alterations are among the most important manifestations of the disease, their pathophysiological mechanisms are not fully understood. We aim to review the up-to-date evidence regarding how the optic nerves are affected, the possible pathophysiology and the methods of their assessment.
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Affiliation(s)
- Nada Elsaid
- Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Omar Ahmed
- Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Tamer Belal
- Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Ahmed Razek
- Faculty of Medicine, Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Ahmed Azab
- Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura, Egypt
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34
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Touzé R, Bonnin S, Houdart E, Nicholson P, Bodaghi B, Shotar E, Clarençon F, Lenck S, Touitou V. Long-term Kinetic Papilledema Improvement After Venous Sinus Stenting in Idiopathic Intracranial Hypertension. Clin Neuroradiol 2020; 31:483-490. [PMID: 32399641 DOI: 10.1007/s00062-020-00908-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the safety and effectiveness of lateral sinus stenosis (LSS) stenting in patients with idiopathic intracranial hypertension (IIH) who are refractory to medical treatment, particularly focusing on visual outcomes including papilledema. MATERIAL AND METHODS Retrospective study of consecutive patients with IIH refractory to medical treatment who underwent LSS stenting. Clinical features, visual fields and optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thicknesses were assessed before stenting, at 1 month poststenting and at last follow-up. Complications were also recorded. RESULTS A total of 16 women were included, with a mean age of 39 ± 11 years. All patients had papilledema while 15/16 (94%) had headaches. Mean visual acuity was 0.036 logMAR, range (+0.4 to +0.0 logMAR). The mean RNFL thickness prior to stenting was 121.7 µm (±34.7 µm) and mean GCL thickness was 80.2 µm (±8.9 µm). Mean follow-up was 19.7 months (±11.8 months). After stenting, acetazolamide was discontinued in 15/16 (94%) patients. Papilledema improved in 14/16 (88%) of patients. The mean RNFL thickness was significantly decreased 1 month after stenting (96.3 ± 15.6 µm; p < 0.001) and at last visit (93.4 ± 15.3 µm; p < 0.001). The GCL thickness after LSS stenting was moderately decreased at the last visit examination: 80.2 ± 8.9 µm vs. 78.0 ± 10.7 µm; (p < 0.01). No stent-related complication occurred, while there was one case of restenosis. CONCLUSION Improvement of papilledema appears to occur relatively rapidly after the LSS stenting. The results further support the role of LSS stenting in the treatment of IIH, especially with respect to visual symptoms.
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Affiliation(s)
- Romain Touzé
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, APHP, 47, Bd de l'Hôpital, 75013, Paris, France.
| | - Sophie Bonnin
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, APHP, 47, Bd de l'Hôpital, 75013, Paris, France.,Department of Ophthalmology, Lariboisière Hospital, APHP, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière Hospital, APHP, Paris, France
| | - Patrick Nicholson
- Joint Division of Medical Imaging, Department of Medical Imaging, UHN, University of Toronto, Toronto, Ontario, Canada
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, APHP, 47, Bd de l'Hôpital, 75013, Paris, France.,Paris VI University, Sorbonne University, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Frédéric Clarençon
- Paris VI University, Sorbonne University, Paris, France.,Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Valérie Touitou
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, APHP, 47, Bd de l'Hôpital, 75013, Paris, France.,Paris VI University, Sorbonne University, Paris, France
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35
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Dreesbach M, Joachimsen L, Küchlin S, Reich M, Gross NJ, Brandt AU, Schuchardt F, Harloff A, Böhringer D, Lagrèze WA. Optic Nerve Head Volumetry by Optical Coherence Tomography in Papilledema Related to Idiopathic Intracranial Hypertension. Transl Vis Sci Technol 2020; 9:24. [PMID: 32742754 PMCID: PMC7354856 DOI: 10.1167/tvst.9.3.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Idiopathic intracranial hypertension (IIH) leads to optic nerve head swelling and optic atrophy if left untreated. We wanted to assess an easy to perform volumetric algorithm to detect and quantify papilledema in comparison to retinal nerve fiber layer (RNFL) analysis using optical coherence tomography (OCT). Methods Participants with and without IIH underwent visual acuity testing at different contrast levels and static perimetry. Spectralis-OCT measurements comprised standard imaging of the peripapillary RNFL and macular ganglion cell layer (GCL). The optic nerve head volume (ONHV) was determined using the standard segmentation software and the 3.45 mm early treatment diabetic retinopathy study (ETDRS) grid, necessitating manual correction within Bruch membrane opening. Three neuro-ophthalmologists graded fundus images according to the Frisén scale. A mixed linear model (MLM) was used to determine differences between study groups. Sensitivity and specificity was evaluated using the area under the receiver-operating characteristic (ROC). Results Twenty-one patients with IIH had an increased ONHV of 6.46 ± 2.36 mm3 as compared to 25 controls with 3.20 ± 0.25 mm3 (P < 0.001). The ONHV cutoff distinguishing IIH from controls was 3.97 mm3 (i.e. no patient with IIH had an ONHV below and no healthy individual above this value). The area under the curve (AUC) for ONHV was 0.99 and for the RNFL at 3.5 mm 0.90. The Frisén scale grading correlated higher with the ONHV (r = 0.90) than with the RNFL thickness (r = 0.68). ONHV measurements were highly reproducible in both groups (coefficient of variation <0.01%). Conclusions OCT-based volumetry of the optic nerve head discriminates very accurately between individuals with and without IIH. It may serve as a useful adjunct to the rating with the subjective and ordinal Frisén scale. Translational Relevance A simple OCT protocol run on the proprietary software of a commercial OCT device can reliably discriminate between normal optic nerve heads or pseudo-papilledema and true papilledema while being highly reproducible. Our normative data and OCT preset may be used in further clinical studies.
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Affiliation(s)
- Michelle Dreesbach
- Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany
| | - Lutz Joachimsen
- Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany
| | - Sebastian Küchlin
- Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany
| | - Michael Reich
- Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany
| | - Nikolai J Gross
- Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Universitätsmedizin, Universität, Berlin, Germany.,Department of Neurology, University of California, Irvine, CA, USA
| | - Florian Schuchardt
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
| | - Daniel Böhringer
- Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany
| | - Wolf A Lagrèze
- Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany
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36
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Price DA, Grzybowski A, Eikenberry J, Januleviciene I, Verticchio Vercellin AC, Mathew S, Siesky B, Harris A. Review of non-invasive intracranial pressure measurement techniques for ophthalmology applications. Br J Ophthalmol 2019; 104:887-892. [PMID: 31704702 DOI: 10.1136/bjophthalmol-2019-314704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 11/04/2022]
Abstract
Assessment and monitoring of intracranial pressure (ICP) are important in the management of traumatic brain injury and other cerebral pathologies. In the eye, ICP elevation and depression both correlate with optic neuropathies, the former because of papilledema and the latter related to glaucoma. While the relationship between ICP elevation and papilledema is well established, the relationship between low ICP and glaucoma is still poorly understood. So far, ICP monitoring is performed invasively, but this entails risks including infection, spurring the study of non-invasive alternatives. We review 11 methods of non-invasive estimation of ICP including correlation to optic nerve sheath diameter, intraocular pressure, ophthalmodynamometry and two-depth transcranial Doppler of the ophthalmic artery. While none of these methods can fully replace invasive techniques, certain measures show great potential for specific applications. Although only used in small studies to date, a MRI based method known as MR-ICP, appears to be the best non-invasive technique for estimating ICP, with two-depth transcranial ultrasound and ophthalmodynamometry showing potential as well.
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Affiliation(s)
- David Andrew Price
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, Poznan City Hospital, Poznan, Poland.,Medcial Faculty, University of Warmia and Mazury, Olsztyn, Poland
| | - Jennifer Eikenberry
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Sunu Mathew
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brent Siesky
- Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Alon Harris
- Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
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37
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Abstract
Introduction: Diagnosis and appropriate management of patients with the pseudotumor cerebri syndrome are imperative to prevent or minimize permanent visual loss and headache-related disability. Areas covered: Steps in management, including making the correct diagnosis, techniques to assess the patient's visual status, medical treatment of intracranial hypertension and the associated headaches, weight management strategies, surgical treatments and stenting are reviewed incorporating the most recent medical evidence. Expert opinion: As the pathogenesis of the pseudotumor cerebri syndrome is still unknown, many of the currently employed management strategies incorporate a 'plumbing approach' to decrease cerebrospinal fluid (CSF) pressure. The Idiopathic Intracranial Hypertension Trial (IIHTT) taught us that the disorder markedly affects visual and overall quality of life, and that reducing pressure alone is not enough to make patients well, even those considered to have 'mild' vision loss. Other than the IIHTT, the evidence supporting the use of various treatments is meager. The course of the disorder can be unpredictable, and the clinician(s) managing these patients are often uncertain about which treatments to employ. Moreover, the desired modalities and specialists are not universally available in all locations. An individualized and detailed approach to the various manifestations and nuances of the disorder is essential.
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Affiliation(s)
- Deborah I Friedman
- Departments of Neurology & Neurotherapeutics and Ophthalmology, University of Texas Southwestern Medical Center , Dallas , TX , USA
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38
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Evaluation of optic nerve head changes with optic coherence tomography in patients with idiopathic intracranial hypertension. Acta Neurol Belg 2019; 119:351-357. [PMID: 30120685 DOI: 10.1007/s13760-018-1000-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/13/2018] [Indexed: 01/03/2023]
Abstract
In the case of mild papilledema, fundoscopy findings may sometimes be insufficient, leading to false and misleading indices in the diagnosis of early-stage idiopathic intracranial hypertension (IIH). This study aims to evaluate these patients through optic coherence tomography (OCT). The study included 54 individuals diagnosed with IIH and 48 healthy individuals in the control group. All patients underwent neurological and ophthalmologic examinations. Opening pressure values of patients' cerebrospinal fluid (CSF) were recorded. We measured the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell complex, cup volume, and the optical disc area, as well as the neuroretinal rim in both groups. A total of 108 eyes from the patient group and 96 eyes from the control group were evaluated. It was found that the mean value of the RNFL thickness of the IIH patients was greater than the control group in the following eight segments: superior nasal, superior temporal, inferior nasal, inferior temporal, nasal superior, nasal inferior, temporal superior, and temporal inferior (p < 0.01 for all). In contrast to the control group, the disc and rim area values of the patient group were higher (p < 0.01), while the cup volume was smaller (p < 0.01) than in the control group. In the patient group, a positive correlation was observed between the papilledema grade and the RNFL thickness (r = 0.64, p < 0.01), CSF opening pressure (r = 0.59, p < 0.01), disc area (r = 0.68, p < 0.01), and rim area (r = 0.70, p < 0.01). Furthermore, RNFL thickness, CSF opening pressure (r = 0.61, p < 0.01), disc area (r = 0.71, p < 0.01), and rim area (r = 0.71, p < 0.01) values were determined to be positively correlated to each other. OCT is believed to contribute to the diagnosis of IIH, by providing reliable data on optical cup volume, optical disc and rim area, and a greater RNFL thickness.
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39
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Patel MD, Malhotra K, Shirazi Z, Moss HE. Methods for Quantifying Optic Disc Volume and Peripapillary Deflection Volume Using Radial Optical Coherence Tomography Scans and Association With Intracranial Pressure. Front Neurol 2019; 10:798. [PMID: 31396151 PMCID: PMC6668216 DOI: 10.3389/fneur.2019.00798] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/10/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: Papilledema and peripapillary deformation of Bruch's membrane (BM) are associated with elevated intracranial pressure (ICP). We have developed a novel methodology to measure these parameters using a radial optical coherence tomography (OCT) scan pattern and apply this to test the hypothesis that ICP is associated with volumetric features of ophthalmic structures. Methods: 6-radial OCT B-scans centered over the optic nerve head were acquired in 17 subjects (30 eyes) before lumbar puncture with measurement of ICP (range: 10–55 cm H2O). Internal limiting membrane (ILM) and BM were segmented. Three definitions of BM were studied to account for imaging artifact affecting peripapillary BM: connecting rater-identified BM margins(traditional), connecting rater-identified BM 1.6 mm on either side of the ONH(estimated), and excluding BM in the central 3.2 mm of the images(excluded). Optic nerve head volume (ONHV), BM displacement volume (BMDV) and cup volume (CV) were calculated by interpolating between B-scans. Ganglion cell complex volume (GCCV) was measured in the macula. Linear generalized estimating equations (GEE) modeled ONVH, BMDV, and CV as a function of ICP and GCCV. Results: Increased ONHV was associated with elevated ICP for traditional (p = 0.006), estimated (p = 0.003) and excluded (p = 0.05) BM definitions. Decreased BMDV was associated with elevated ICP for traditional (p < 0.0005), estimated (p < 0.0005) and excluded (p = 0.001) definitions. Decreased ONHV was independently associated with decreased GCCV (p = 0.001) and decreased ICP (p = 0.031) in multivariable models. CV was neither associated with ICP nor GCCV in univariate or multivariable models. Conclusions: Elevated ICP is associated with ONHV increase and BMDV decrease, calculated from OCT images accounting for image artifact. Ganglion cell atrophy affects the relationship between ICP and ONHV. OCT derived volumetric measures of the posterior eye may have application as biomarkers for elevated ICP.
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Affiliation(s)
- Megh Dipak Patel
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
| | - Kiran Malhotra
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Zainab Shirazi
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Heather E Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
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40
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Mitchell JL, Mollan SP, Vijay V, Sinclair AJ. Novel advances in monitoring and therapeutic approaches in idiopathic intracranial hypertension. Curr Opin Neurol 2019; 32:422-431. [PMID: 30865008 PMCID: PMC6522204 DOI: 10.1097/wco.0000000000000690] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The current article appraises the recent developments in idiopathic intracranial hypertension (IIH), with particular attention to novel therapeutic avenues and advanced clinical assessment and monitoring with optical coherence tomography and telemetric intracranial pressure devices. RECENT FINDINGS The incidence of IIH is increasing. The first consensus guidelines for IIH have been published detailing investigation and management algorithms for adult IIH. Improved understanding, clinical assessment and monitoring are emerging with the use of optical coherence tomography. Intracranial pressure telemetry is providing unique insights into the physiology of raised intracranial pressure in IIH. There are now an increasing number of ongoing clinical trials evaluating weight loss methods and novel targeted therapies, such as 11ß-HSD1 inhibition and Glucagon-like peptide 1 (GLP-1) receptor agonists. SUMMARY Several studies are evaluating new therapies for IIH. Monitoring techniques are advancing, aiding diagnosis and allowing the clinician to accurately evaluate changes in papilloedema and intracranial pressure.
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Affiliation(s)
- James L. Mitchell
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham
- Department of Neurology, University Hospitals Birmingham
| | | | - Vivek Vijay
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham
- Department of Neurology, University Hospitals Birmingham
| | - Alexandra J. Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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41
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Huang‐Link Y, Eleftheriou A, Yang G, Johansson JM, Apostolou A, Link H, Jin Y. Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema. Eur J Neurol 2019; 26:808-e57. [DOI: 10.1111/ene.13893] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Y. Huang‐Link
- Department of Neurology Institution of Clinical and Experimental Medicine (IKE) Linköping University Hospital Linköping Sweden
| | - A. Eleftheriou
- Department of Neurology Institution of Clinical and Experimental Medicine (IKE) Linköping University Hospital Linköping Sweden
| | - G. Yang
- School of First Clinical Medicine Southern Medical University Guangzhou China
| | - J. M. Johansson
- Department of Ophthalmology IKE Linköping University Hospital Linköping
| | - A. Apostolou
- Department of Neurology Institution of Clinical and Experimental Medicine (IKE) Linköping University Hospital Linköping Sweden
| | - H. Link
- Department of Neuroscience Karolinska Institute Stockholm Sweden
| | - Y.‐P. Jin
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
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42
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White O, Yalamanchili S. IIH: Optic Nerve Sheath Fenestration Versus Shunt Placement. Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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43
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Abstract
PURPOSE OF REVIEW To provide a current review of recent publications with regards to intracranial hypertension. RECENT FINDINGS Attempts were made to provide pediatric data; however, the recent completion of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) has provided a wealth of data with regards to adult intracranial hypertension.The pediatric incidence of intracranial hypertension ranges between 0.63 and 0.71 per 100 000 children. A majority of pediatric cases responded to acetazolamide, with resolution of headache averaging 3.8 weeks. Most patients require less than 1 year of treatment with male sex, older age at diagnosis, primary intracranial hypertension, and lack of headache being predictors of good response. Fluorescein angiography has the highest accuracy in distinguishing true papilledema from pseudopapilledema. The IIHTT found Frisen grade of papilledema was within 1 grade in 92.8% of patients. Monitoring of potassium levels is not required and aplastic anemia was not seen in patients taking acetazolamide. SUMMARY Although the newer pediatric studies report incidence rates in pediatric intracranial hypertension are lower than seen in adults, intracranial hypertension is still a concern in pediatrics. There has been a wealth of information with regards to symptomatology, treatment, and outcomes from the IIHTT that will hopefully assist with management in the pediatric population.
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44
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Diffusion tensor imaging of the optic disc in idiopathic intracranial hypertension? Neuroradiology 2018; 61:17-18. [PMID: 30488256 DOI: 10.1007/s00234-018-2144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
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45
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Sheils CR, Fischer WS, Hollar RA, Blanchard LM, Feldon SE. The Relationship Between Optic Disc Volume, Area, and Frisén Score in Patients With Idiopathic Intracranial Hypertension. Am J Ophthalmol 2018; 195:101-109. [PMID: 30081012 PMCID: PMC6214729 DOI: 10.1016/j.ajo.2018.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare measurements of papilledema using fundus photography, optical coherence tomography (OCT), and Frisén score in patients with idiopathic intracranial hypertension (IIH). DESIGN Retrospective, noncomparative analysis of randomized controlled trial data. METHODS The Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) evaluated weight management and treatment with acetazolamide compared with placebo in patients with IIH and mild visual loss. Among the 126 subjects in the IIHTT OCT substudy, fundus photographs and OCT scans of the optic disc were taken at baseline and at 6 and 12 months after enrollment. Trained readers scored each eye using a modified Frisén scale and measured the area of disc elevation. OCT scans assessed optic nerve head (ONH) volume. Correlations between volume and area were computed for both study and nonstudy eyes. RESULTS Disc area and ONH volume were positively correlated at baseline (R2 = 0.77 in study eyes, P < .001). Correlations between area and volume were similar in the treatment groups at baseline, but were weaker in the acetazolamide group compared with the placebo group at 6 months (R2 = 0.25 vs R2 = 0.76 in study eyes) and 12 months (R2 = 0.19 vs R2 = 0.65 in study eyes). At 6 and 12 months after enrollment, there was no consistent relationship between Frisén score, disc area, and ONH volumes in the acetazolamide group. CONCLUSION Frisén score fails to reflect the photographic area and OCT volume of papilledema after treatment with acetazolamide. Clinicians should use caution when using the Frisén scale to monitor the effect of treatment on papilledema over time.
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Affiliation(s)
- Catherine R Sheils
- University of Rochester School of Medicine & Dentistry, Rochester, New York, USA; Department of Ophthalmology, David & Ilene Flaum Eye Institute, Rochester, New York, USA
| | - William S Fischer
- University of Rochester School of Medicine & Dentistry, Rochester, New York, USA; Department of Ophthalmology, David & Ilene Flaum Eye Institute, Rochester, New York, USA
| | - Rachel A Hollar
- University of Rochester School of Medicine & Dentistry, Rochester, New York, USA; Department of Ophthalmology, David & Ilene Flaum Eye Institute, Rochester, New York, USA
| | - Lisa M Blanchard
- University of Rochester School of Medicine & Dentistry, Rochester, New York, USA; Department of Ophthalmology, David & Ilene Flaum Eye Institute, Rochester, New York, USA
| | - Steven E Feldon
- University of Rochester School of Medicine & Dentistry, Rochester, New York, USA; Department of Ophthalmology, David & Ilene Flaum Eye Institute, Rochester, New York, USA.
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Hatem CF, Yri HM, Sørensen AL, Wegener M, Jensen RH, Hamann S. Long-term visual outcome in a Danish population of patients with idiopathic intracranial hypertension. Acta Ophthalmol 2018; 96:719-723. [PMID: 29405582 DOI: 10.1111/aos.13664] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/06/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure (ICP), normal cerebrospinal composition and exclusion of alternative causes to increased ICP. The aim of this study was to evaluate long-term visual outcome in a Danish population of IIH patients. METHODS Retrospective chart review of 41 women diagnosed with IIH between June 2007 and March 2013. Best-corrected visual acuity (BCVA), colour vision, grade and type of visual field (VF) defects and grade of papilloedema according to the Modified Frisén Score were recorded at baseline visit (V0), 2-6 months (V1) and 13 months follow-up visit (V2) from time of diagnosis. RESULTS Best-corrected visual acuity (BCVA) was reduced in 25% of eyes at V0, in 10% at V1 and in 15% at V2. Colour vision was barely affected. Visual field (VF) was affected (>grade 0) in 87% of eyes at V0 and VF defect grade significantly improved by 0.58 at V1 (p-value <0.0001) and by 0.55 at V2 (p-value <0.001). The most common type of VF defect at V0 was a nerve fibre layer defect (56.4%), and the second most common type was an enlarged blind spot (20.5%). There was no correlation between BCVA and VF defect type. Mean grade of papilloedema decreased from 2.2 at V0 to 0.5 at V2. The grade of papilloedema at V2 was not significantly related to the severity of papilloedema at V0 (p-values 0.65 and 0.48). CONCLUSION Idiopathic intracranial hypertension (IIH) is associated with long-term loss of visual function, and relevant treatment strategies need to be improved.
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Affiliation(s)
- Christina F. Hatem
- Department of Ophthalmology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Hanne M. Yri
- Danish Headache Center; Department of Neurology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Anne L. Sørensen
- Department of Biostatistics; University of Copenhagen; Copenhagen Denmark
| | - Marianne Wegener
- Department of Ophthalmology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Rigmor H. Jensen
- Danish Headache Center; Department of Neurology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Steffen Hamann
- Department of Ophthalmology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Skipper NT, Igra MS, Littlewood R, Armitage P, Laud PJ, Mollan SP, Sharrack B, Pepper IM, Batty R, Connolly DJA, Hickman SJ. Do Optic Canal Dimensions Measured on CT Influence the Degree of Papilloedema and Visual Dysfunction in Idiopathic Intracranial Hypertension? Neuroophthalmology 2018; 43:3-9. [PMID: 30723518 DOI: 10.1080/01658107.2018.1483406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022] Open
Abstract
A recent study found that increased optic canal area on magnetic resonance imaging was associated with worse papilloedema in idiopathic intracranial hypertension (IIH). We repeated this study using more accurate computerized tomography derived measurements. Optic canal dimensions were measured from 42 IIH patients and 24 controls. These were compared with papilloedema grade. There was no correlation between any of the optic canal measurements and papilloedema grade and no significant difference in optic canal measurements between patients and controls. Our results cast doubt on the existing literature regarding the association between optic canal size and the degree of papilloedema in IIH. CT delineates bony anatomy more accurately than MRI and our CT-derived optic canal measurements cast doubt on the existing literature regarding the association between optic canal size and the degree of Papilloedema in IIH.
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Affiliation(s)
| | - Mark S Igra
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Paul Armitage
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Peter J Laud
- Statistical Services Unit, University of Sheffield, Sheffield, UK
| | - Susan P Mollan
- Department of Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
| | - Basil Sharrack
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK.,National Institute for Health Research, Sheffield Neuroscience Biomedical Research Centre, Sheffield, UK
| | - Irene M Pepper
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Ruth Batty
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Simon J Hickman
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
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Abstract
PURPOSE OF REVIEW This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another. RECENT FINDINGS A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial-IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone. Furthermore, management of IIH-related headache, even in patients with papilledema, may require treatment other than ICP lowering for patients to experience symptomatic relief. Finally, a number of uncontrolled interventional studies have shown transverse sinus stenting to be a potentially effective treatment for medically refractory IIH. Medical therapy with acetazolamide should be considered in addition to structured weight loss in patients with mild IIH. Surgical treatment for patients with vision-threatening disease IIH can be performed by either optic nerve sheath fenestration or cerebrospinal fluid diversion, with venous sinus stenting emerging as an alternate therapy. Headache relief from ICP lowering therapy is variable and often not sustained.
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Affiliation(s)
- Sivashakthi Kanagalingam
- Department of Surgery, Division of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Prem S Subramanian
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, 1675 Aurora Court, Mailstop F-731, Aurora, CO, 80045, USA.
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Shen G, Link S, Kumar S, Nusbaum DM, Tse DY, Fu Y, Wu SM, Frankfort BJ. Characterization of Retinal Ganglion Cell and Optic Nerve Phenotypes Caused by Sustained Intracranial Pressure Elevation in Mice. Sci Rep 2018; 8:2856. [PMID: 29434244 PMCID: PMC5809383 DOI: 10.1038/s41598-018-21254-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/31/2018] [Indexed: 12/16/2022] Open
Abstract
Elevated intracranial pressure (ICP) can result in multiple neurologic sequelae including vision loss. Inducible models of ICP elevation are lacking in model organisms, which limits our understanding of the mechanism by which increased ICP impacts the visual system. We adapted a mouse model for the sustained elevation of ICP and tested the hypothesis that elevated ICP impacts the optic nerve and retinal ganglion cells (RGCs). ICP was elevated and maintained for 2 weeks, and resulted in multiple anatomic changes that are consistent with human disease including papilledema, loss of physiologic cupping, and engorgement of the optic nerve head. Elevated ICP caused a loss of RGC somas in the retina and RGC axons within the optic nerve, as well as a reduction in both RGC electrical function and contrast sensitivity. Elevated ICP also caused increased hypoxia-inducible factor (HIF)-1 alpha expression in the ganglion cell layer. These experiments confirm that sustained ICP elevation can be achieved in mice and causes phenotypes that preferentially impact RGCs and are similar to those seen in human disease. With this model, it is possible to model human diseases of elevated ICP such as Idiopathic Intracranial Hypertension and Spaceflight Associated Neuro-ocular Syndrome.
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Affiliation(s)
- Guofu Shen
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Schuyler Link
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Sandeep Kumar
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Derek M Nusbaum
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Dennis Y Tse
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Yingbin Fu
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Samuel M Wu
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Benjamin J Frankfort
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA. .,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
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50
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Saenz R, Cheng H, Prager TC, Frishman LJ, Tang RA. Use of A-scan Ultrasound and Optical Coherence Tomography to Differentiate Papilledema From Pseudopapilledema. Optom Vis Sci 2017; 94:1081-1089. [PMID: 29120977 PMCID: PMC5726530 DOI: 10.1097/opx.0000000000001148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Differentiating papilledema from pseudopapilledema reflecting tilted/crowded optic discs or disc drusen is critical but can be challenging. Our study suggests that spectral-domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness and retrobulbar optic nerve sheath diameter (ONSD) measured by A-scan ultrasound provide useful information when differentiating the two conditions. PURPOSE To evaluate the use of A-scan ultrasound and spectral-domain OCT retinal nerve fiber layer thickness (RNFLT) in differentiating papilledema associated with idiopathic intracranial hypertension from pseudopapilledema. METHODS Retrospective cross-sectional analysis included 23 papilledema and 28 pseudopapilledema patients. Ultrasound-measured ONSD at primary gaze, percent change in ONSD at lateral gaze (30° test), and peripapillary RNFLT were analyzed. Receiver operating characteristic curves were constructed using one eye from each subject. RESULTS Compared with pseudopapilledema, papilledema eyes showed larger mean ONSD (5.4 ± 0.6 vs. 4.0 ± 0.3 mm, P < .0001), greater change of ONSD at lateral gaze (22.4 ± 8.4% vs. 2.8 ± 4.8%, P < .0001), and thicker retinal nerve fiber layer (219.1 ± 104.6 vs. 102.4 ± 20.1 μm, P < .0001). Optic nerve sheath diameter and 30° test had the greatest area under the receiver operating characteristic curve, 0.98 and 0.97, respectively; followed by inferior quadrant (0.90) and average RNFLT (0.87). All papilledema eyes with Frisén scale greater than grade II were accurately diagnosed by ONSD, 30° test, or OCT. In mild papilledema (Frisén scale grades I and II, n = 15), area under the receiver operating characteristic curve remained high for ONSD (0.95) and 30° test (0.93) but decreased to 0.61 to 0.71 for RNFLT. At 95% specificity, sensitivities for ONSD, 30° test, and RNFLT were 91.3%, 91.3%, and 56.5%, respectively, for the entire papilledema group and 80.0%, 86.7%, and 13.3% for the mild papilledema subgroup. CONCLUSIONS Retinal nerve fiber layer thickness can potentially be used to detect moderate to severe papilledema. A-scan may further assist differentiation of mild papilledema from pseudopapilledema.
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Affiliation(s)
- Roberto Saenz
- College of Optometry, University of Houston, Houston, Texas
| | | | - Thomas C Prager
- Department of Ophthalmology, Methodist Hospital Research Institute, Weill Cornell Medical College, Houston, Texas *
| | | | - Rosa A Tang
- College of Optometry, University of Houston, Houston, Texas
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